EFFICACY OF COLD PACK THERAPY ON SORENESS BEFORE MYOFASCIAL TRIGGER POINT DRY NEEDLING: A SINGLE-BLIND RANDOMIZED CONTROLLED TRIAL

Background: Myofascial pain syndrome (MPS) is a common condition characterized by pain originating from myofascial trigger points (MTrP) in skeletal muscle. Several treatment approaches exist, including dry needling. However, post-needling muscle soreness is a common adverse effect of dry needling. Previous research has investigated the effectiveness of cryotherapy after needling for treating post-needling soreness; however, it has shown no statistically significant effect. In addition, the impact of cryotherapy before dry needling has not been adequately investigated. Objective: The study aimed to evaluate the efficacy of cryotherapy applied prior to dry needling in reducing post-needling soreness in patients with upper trapezius MTrP. Methods: This single-blinded, randomized controlled trial study was conducted among 60 participants diagnosed with upper trapezius MPS at the Rehabilitation Medicine outpatient clinic. They were randomly allocated to one of two groups: (1) cold pack therapy prior to dry needling (intervention group) or (2) no cold pack therapy prior to dry needling (control group). Skin temperature was recorded immediately before needle insertion. Pain intensity was evaluated using a 100-mm visual analog scale (VAS) during needle insertion, 10 minutes after the procedure, and on the second day post-intervention. Results: The intervention group demonstrated significantly lower VAS scores compared to the control group for pain during needle insertion (0 vs. 60, p < 0.001), soreness 10 minutes post-procedure (10 vs. 80, p < 0.001), and on Day 2 (0 vs. 40, p < 0.001). The intervention group experienced significantly shorter post-needling soreness duration compared to the control group (0.13 vs. 3 days, p < 0.001). Additionally, acetaminophen use was not necessary in the intervention group when compared to the control group (0% vs. 24.1%, p < 0.01). No adverse events were reported in either group during the study. Conclusions: Pre-procedure cold pack therapy significantly reduces pain during needle insertion and post-needling soreness at 10 minutes and on Day 2.